title: Salvage periaortic pericardial baffle equalizes mortality in bleeding patients undergoing aortic surgery.
abstract: OBJECTIVE
  Bleeding is a potentially serious complication of aortic surgery. We report our experience with the use of a periaortic bovine pericardial baffle to control intractable intraoperative bleeding.
  
  
  METHODS
  All patients who underwent aortic root, ascending, or arch replacements between January 2002 and April 2013 were reviewed. A bovine pericardial periaortic baffle was created to shunt shed blood into the right atrium. The transverse sinus was sutured closed in patients undergoing primary sternotomy. Baffle recipients were compared with the remaining patients undergoing aortic surgery. The Fisher exact test was used to determine statistical significance for categoric variables. Continuous variables were compared using the nonparametric Wilcoxon rank-sum test. All factors with a P value less than .2 were considered for multivariate logistic regression to determine independent associations with baffle use.
  
  
  RESULTS
  A total of 413 patients were identified, of whom 23 received a baffle. Operative mortality for patients receiving a baffle was 4% (1/23) compared with 6% (25/390) (P = 1) for the remaining patients. Prolonged ventilation was more common in the baffle recipients (P < .0005); otherwise, there were no differences in postoperative morbidity. Multivariate analysis of all patients undergoing aortic surgery revealed infectious endocarditis (P < .0005; odds ratio, 15.1; 95% confidence interval, 4.8-47.2), redo sternotomy (P < .0005; odds ratio, 11.9; 95% confidence interval, 4.1-34.1), and male gender (P = .04; odds ratio, 4.6; 95% confidence interval, 1.1-19.3) to be predictive of baffle placement.
  
  
  CONCLUSIONS
  Patients requiring salvage periaortic pericardial baffle for intractable intraoperative hemorrhage experienced an operative mortality similar to that in the remaining patients undergoing aortic surgery. Infectious endocarditis requiring root replacement or reoperative aortic surgery should alert the surgeon to the potential need for baffle placement, including prophylactic transverse sinus closure.
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC. Electronic address: toole@musc.edu.
authors.forename: John Matthew
authors.initials: JM
authors.lastname: Toole
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Martha R
authors.initials: MR
authors.lastname: Stroud
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: John S
authors.initials: JS
authors.lastname: Ikonomidis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001011:Aorta / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D002417:Cattle; D005260:Female; D064593:Heterografts; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010496:Pericardium / Q000637:transplantation*; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D016896:Treatment Outcome; D055815:Young Adult